POTW May 10, 2010 thru May 14, 2010

Jethro and Gator were in a VERY close race last week, but Jethro finally won 66 to 62.

Great race, boys!!

PATIENT SUMMARY:

Lucy is a Golden Retriever. She is 9yrs old and weighs 78#. Dr. Greg Hartman of Hartman Animal Hospital was her referring veterinarian. Lucy had acute onset of right rear lameness 2 weeks previous. Dr. Hartman identified a right CCL injury. Upon exam by Dr. Dew, there was positive anterior drawer consistent with right CCL rupture, and two soft tissue masses: one left of midline at the level of the last mammary gland and one on the left scapula. Both were 2cm in diameter, which upon palpitation were the consistency of a lipoma. Dr. Dew discussed the TTA (tibial tuberosity advancement) procedure, recovery and prognosis as well as mass excision and histologic assessment. Lucy’s owner decided to proceed with a TTA and mass removal.
TREATMENT:
Dr. Dew used a medial approach with medial arthrotomy. He advanced the tuberosity and stabilized with Kyon 12x22mm basket, 6 hole plate & fork, and 4 titanium screws. The lipomas were removed from ventral midline and left scapula. They were submitted to AR-state lab. Lucy’s prognosis is good for healing, improved function and decreased progression of degenerative joint disease (arthritis). Nursing care, physical therapy, exercise restriction and the use of Glycoflex will play critical roles in an uncomplicated recovery and optimization of long term function. With the TTA procedure, it is not uncommon to see some bruising and edema around the hock (ankle) and on the inside of the leg below the incision. These changes are not painful and will resolve without treatment in 3-10 days. The masses removed appeared to be lipoma's the laboratory will confirm this diagnosis.

PATIENT SUMMARY:
Deja is a 27.5#, 9mo old Mix Breed. She was referred to us by Dr. Kathleen McCune of McCune Animal Hospital. Deja was HBC 2 weeks previous, and suffered a right femoral distal physeal fracture. This was stabilized with single IM pin, but stability has not been maintained. Dr. Dew discussed pin removal and fracture stabilization with divergent IM pins, with good prognosis for bone healing and return to weight bearing function. Her owner wished to proceed with fracture stabilization as discussed.
TREATMENT:
Dr. Dew used a lateral approach through the previous incision. The placed IM pin was removed, and a bacterial culture was submitted to AR-State Lab. The fracture was then stabilized with 7/64 divergent IM pins. Deja’s prognosis is good for normal osseous healing. Exercise restrictions must be followed to maximize the prognosis for uncomplicated healing. Due to multiple surgeries, "Deja" will benefit from physical therapy to improve the range of motion in her stifle.

PATIENT SUMMARY:
Maggie is a 10yr old 85# Labrador Retriever. She was referred by Dr. Heath Stump with Russellville Animal Clinic. Maggie had begun to have issues with hardware irritation on the medial aspect of the left stifle from a previous surgery. Radiographs demonstrated a cerclage wire knot that was elevated. Dr. Dew’s discussion with Maggie’s owner included hardware removal and bone graft placement. She brought Maggie in currently to have hardware removed and bone graft placed.
TREATMENT:
Dr. Dew used a medial approach for the hardware removal. All hardware was successfully removed, and the tibial tuberosity was stable. Maggie’s prognosis is good for healing of the bone and soft tissues.

PATIENT SUMMARY:
Jade is a Pit Bull. She is 8 yrs old and weighs 55#. Cheree Miller, our Practice Manager is her mommy. Unknown trauma resulted in non-weight bearing lameness on her right rear. Radiographs demonstrated a comminuted fracture of the mid-diaphysis, consistent with low speed injury. Dr. Dew discussed use of ESF (external stabilization fixator) for stabilization, and Ms. Miller wished to proceed.
TREATMENT:
Dr. Dew used a closed approach to place the stabilization hardware. He used Construct Type II composite fixator 1" acrylic bars, 4 large center thread, 1 small center thread, 1-3/16 full thread 1/2 pin, and a 1-1/8 transcortical pin. Jade’s prognosis is good for normal osseous healing. Exercise restrictions must be followed to maximize the prognosis for uncomplicated healing.

PATIENT SUMMARY:
Sophie is a 7mo old 14# Miniature Schnauzer. Her referring veterinarian is Dr. Donna Hunter of Interstate Animal Clinic. 5 months post correction of right ectopic ureter, Sophie continues to be incontinent and suffers from chronic dermatitis. Upon exam by Dr. Dew, he noted severe perivulvar dermatitis, coat is urine soaked, and vulva conformation appears normal. Dr. Dew discussed urine culture and IVP; if a problem is identified, correction may be possible and lead to a significant improvement in quality of life. Sophie’s owner wished to proceed with culture and IVP.
TREATMENT:
Dr. Dew used a ventral celiotomy approach. The IVP was performed using 12ml of contrast. He observed a Left hydroureter, with no entry in to bladder noted. He had previously transplanted right ureter, and it appeared normal in size and patent. He notified Sophie’s owner of his findings and she decided to proceed with cystotomy for left ectopic ureter transplantation. This was done with drop-in technique. Sophie’s prognosis is good for improved urine retention.

PATIENT SUMMARY:
Meko is a Shih Tzu/Pek mix. She is 11yrs old and weighs 15#. Her referring veterinarian is Dr. Bob Mills with North Arkansas Veterinary Clinic. Meko demonstrated progressive rear limb ataxia, with dysfunction over the past 6 months. Upon Dr. Dew’s examination, she exhibited bilateral rear limb proprioceptive loss with the right being more than the left. Panniculus absent caudal to T10, Grade III/IV rear limb paresis. Also, she had Left grade II MPL (medial patellar luxation). Dr. Dew discussed the presence of spinal cord lesion, offered MRI or myelogram. He discussed risks of anesthesia, myelogram and surgery versus continued conservative therapy. Meko’s owners wished to proceed with cerebrospinal centesis, myelogram and surgery if indicated.
TREATMENT:
Cerebrospinal centesis: 2ml clear CSF collected from cisterna magna; however, this was not submitted as the myelogram is described below.
Myelogram: Using a lumber injection of 3ml of iohexol, a ventral lesion was seen at T12-13, with spinal cord compromised 50%.
Hemilaminectomy: Dr. Dew used a dorsolateral approach to T12/13 vertebra. There was significant osseous stenosis and fibrous hypertrophy laterally, chronic ventral disc herniation, and the cord was decompressed laterally and ventrally. Dr. Dew removed proliferative osseous tissue, and fibrous disc lateral to cord. He performed a ventral decompression to remove chronic disc material. Meko’s prognosis is good for healing and improved neurologic function. A transient worsening of neurologic function can be noted after a myelogram and surgery. This condition will usually resolve to the pre-operative state in 3-10 days. The nervous system is very slow to heal. Improvement can be expected for up to 5 months. Nursing care, physical therapy and exercise restriction all play critical roles in avoiding complications and aiding recovery.